PB2306: REAL-WORLD FIRST-LINE TREATMENT AND OUTCOMES AMONG PATIENTS WITH HIGH-RISK DIFFUSE LARGE B-CELL LYMPHOMA TREATED WITH STANDARD OF CARE
Authors: Jiali Yan, Shilpa Shahani, Nancy Smith, Fang Sun, Qinghua Song, Hairong Xu, Jie Zhang, Umar Farooq
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Rituximab in combination with an anthracycline-containing regimen has been the standard of care (SOC) for diffuse large B-cell lymphoma (DLBCL) in the first-line (1L) setting. While approximately 60% of patients develop durable responses, there is significant heterogeneity in treatment outcomes. Prior studies have reported poor prognoses in subgroups of patients, such as those with high International Prognostic Index score (IPI; Sehn LH and Salles G. N Engl J Med. 2021). Aims: In this study, we describe treatment outcomes in a cohort of patients with high-risk DLBCL who received SOC in the 1L compared with those at lower risk. Methods: A retrospective cohort study was conducted using the COTA DLBCL database, which contains longitudinal data curated from electronic health records from community and academic centers. The study population consisted of adult patients (≥18 years) diagnosed with de novo DLBCL from 2010-2020 who received ≥1 cycle of R-CHOP (rituximab [R], cyclophosphamide [C], doxorubicin [H], vincristine [O], and prednisone [P]) or R-EPOCH (R-CHOP plus etoposide [E]) in the 1L. Patients were excluded if there were data quality issues or concerns, eg, imprecise date of outcome assessment. High-risk was defined as having an IPI ≥4 and/or positive for double/triple-hit lymphoma (D/TH) at diagnosis. Follow-up started at initiation of the 1L regimen and ended at the earlier of death or last visit. Descriptive statistics were used to characterize patient demographic and clinical characteristics at diagnosis. Time to event outcomes, including progression-free survival (PFS) and time to next treatment or death since 1L initiation (TTNT), were analyzed using the Kaplan-Meier method and log rank testing. Results: The study identified 390 eligible patients: 124 met the high-risk definition; 266 did not (comparators). Most high-risk patients had an IPI ≥4 (n=98), 26 had D/TH (IPI <4 or unknown). High-risk patients were older (median, 69 versus 59 years), and more high-risk patients had stage III/IV disease (89% versus 55%), ECOG ≥2 (41% versus 5%), elevated serum lactate dehydrogenase levels (85% versus 46%), and received R-EPOCH (36% versus 22%) versus comparators. Median follow-up was 24 and 40 months in high-risk patients and comparators, respectively. Outcomes were significantly poorer for high-risk patients, with a median PFS of 7 months and a median TTNT of 9 months, whereas the medians were not reached in comparators. For high-risk patients versus comparators, 12- and 24-month PFS were 38.9% and 30.8% versus 65.7% and 58.9% (P<.001), respectively. By 12 and 24 months, respectively, 56.8% and 67.9% of high-risk patients initiated a second-line regimen versus 33.1% and 40.4% among comparators (P<.001). Summary/Conclusion: Patients with high-risk DLBCL from a contemporaneous population-based cohort who received 1L SOC had poor disease outcomes. Our findings highlight the need for alternative treatment strategies for this population in the 1L setting. Keywords: Real world data, CAR-T, CHOP, Lymphoma